Mental Health Test #1 EAQs: Chpt 1-9, 19

What initial assessments should the nurse implement in order to determine a proper plan of treatment and care for a client diagnosed with a substance abuse disorder? Select all that apply. A. Clinical examination of background B. Pattern of substance use C. Strengths and level of willingness to change D. Willingness for a referral to a support group E. Assessment of comorbidities F. Assessment of measures to prevent relapse

A, B, C, E The initial assessment involves a clinical examination of the background, including the client's history, any history of trauma, family history of substance use or mental health problems, and any disabilities. Knowledge about the pattern of substance use such as the type of substance, the frequency, the age at initiation, and so forth helps in properly planning the treatment and care. An individual's strengths and level of willingness to undergo the treatment helps planning the treatment strategy. Assessment of comorbidities is also taken, as they may need to be treated simultaneously. A discussion pertaining to a support group takes place in the planning phase and a support group is involved in the treatment process. It is not a part of the initial assessment. The relapse prevention measures are discussed after the detoxification or rehabilitation is done successfully. (ch. 19)

Behavior modification methods would be most successful when applied to which individuals? Select all that apply. A. The 3-year-old who bites others when angry B. The 13-year-old who regularly disregards family rules C. The 38-year-old who is grieving the loss of a spouse and child D. The 9-year-old who has displayed aggression towards a teacher E. The 25-year-old who is depressed over being rejected for graduate school

A, B, D Behavioral methods are particularly effective with maladaptive behaviors, so the child who bites, the unruly teen, and the aggressive school-aged child are likely best suited to this method. The individuals grieving and depressed are less suited to this method. (Ch. 3)

Which neurotransmitters are responsible for the hallucinations, anxiety, and altered thought processes being experienced by a client experiencing a schizophrenic psychotic episode? A. Dopamine (DA) B. Norepinephrine (NE) C. Serotonin (S-HT) D. Gamma aminobutyric acid (GABA) E. Acetylcholine (ACh)

A, B, D The characteristic increases in DA and NE in combination with a decrease in GABA are responsible for the classic symptoms of a schizophrenic psychotic episode. S-HT and ACh are not related to this disorder. (Ch. 4)

According the American Nurses Association (ANA), advocacy in nursing includes a commitment to which factors? Select all that apply. A. Alleviation of suffering in death B. Clients' well-being C. Helping and trusting relationships D. Safety across the lifespan E. Nurturing individuals' beliefs

A, B, D According to the ANA, advocacy in nursing includes alleviating suffering in death and having a commitment to a client's well-being, and safety across the lifespan. Helping and trusting relationships and nurturing individuals' beliefs are two of the Ten Caritas (loving principles) identified by Dr. Jean Watson. (Ch. 1)

Which statements regarding the effects of pharmacogenetics on medication administration-related nursing care are true? A. Pharmacogenetics makes the prescribing of medications more client-specific. B. Pharmacogenetics focuses on how genes affect individual responses to medicines. C. In the future, cardiac enzymes may be used to determine a client-specific medication dosage. D. Genetic variations in a group of cytochrome enzymes can exist in various ethnic populations. E. Cytochrome P-450 (CYP) enzymes are involved in the metabolizing of most antidepressant medications.

A, B, D, E By understanding how genes influence drug responses, clinicians may one day be able to prescribe drugs best suited for each individual, in other words, in a more client-specific way. The relatively new field of pharmacogenetics focuses on how genes affect individual responses to medicines. An important variation that impacts the ability to metabolize drugs relates to the more than 20 CYP enzymes present in human beings. Genetic variations in these enzymes may alter drug metabolism, and these variations tend to be propagated through racial and ethnic populations. CYP enzymes metabolize most antidepressants and antipsychotics. One purpose of genetic testing in the future will be to enable clinicians to determine correct drugs and dosage using liver enzymes, not cardiac enzymes. (Ch. 4)

Which rights of mentally ill clients are protected by most state laws? Select all that apply. A. The right to vote B. The right to medical treatment C. The right to financial support from the government D. The right to freedom of religion E. The right to social interaction

A, B, D, E Mentally ill clients have the same rights as any healthy person, and state laws are designed to protect these rights. These rights include the right to vote, the right to seek medical treatment for illness, the right to practice any religion, and the right to social interaction. Mentally ill clients do not necessarily have the right to financial support from the government. (Ch. 6)

A nurse assessing a client experiencing withdrawing from cocaine will likely observe which clinical findings? Select all that apply. A. Fatigue B. Depression C. Increased energy D. Decreased appetite E. Apathy

A, B, E Cocaine is a stimulant, and its withdrawal symptoms may include fatigue, depression, and apathy. Cocaine overdose may cause increased energy and decreased appetite due to its stimulant effect. (Ch. 19)

What standards does Quality and Safety Education for Nurses (QSEN) identify? Select all that apply. A. Evidence-based practice B. Informatics C. Nursing research D. Patient-centered care E. Quality Improvement

A, B, E QSEN's six standards include evidence-based practice, informatics, patient-centered care, and quality improvement, as well as teamwork and collaboration and safety. Nursing research is not one of the QSEN standards. (Ch. 1)

Which response made by the nurse provides appropriate information about the civil rights afforded to a legally insane client? A. "The client has the right to refuse antipsychotic medications." B. "The client is hospitalized for up to 5 months without an interim court appearance." C. "The client has a right to file a petition for a writ of habeas corpus." D. "The client must be certified as legally insane by a primary health care provider." E. "The client must be able to provide informed consent for hospitalization.

A, C A client who is considered to be legally insane is admitted to the hospital through an involuntary admission procedure. This client has the same civil rights as clients who are not legally insane; therefore, this client has the right to refuse treatment with antipsychotic medications. If the client feels he or she is being held in the hospital without any cause, the client can file a petition for a writ of habeas corpus. The client is held in the hospital for 60 days, not 5 months, with interim court appearances. The client's illness must be certified at least by two primary health care providers; this number may increase depending on that particular state's laws and regulations. Because the client is legally insane, he or she does not have to provide informed consent in order to be hospitalized. (Ch. 6)

Evidence-based practice in nursing incorporates what factors? Select all that apply. A. Clinical research B. Nurse's treatment preferences C. Nurse's clinical knowledge D. Nurse's experience E. Client's preferences and desires

A, C, D Evidence-based practice in nursing incorporates clinical research, as well as evidence that is not found in research studies. The nurse's clinical knowledge and experience, as well as the client's preferences and desires, are also incorporated. Nursing treatment preferences are not relevant to evidence-based practice. (Ch. 1)

The nurse is admitting a client to the hospital who is taking amitriptyline for depression. Which should the nurse prioritize in this client's assessment? Select all that apply. A. Suicidal ideation B. Physical pain C. Affect D. Family responsibilities E. Constipation

A, C, E Multiple pharmacological mechanisms of TCAs have proven beneficial in treating difficult cases of depression and chronic pain. However, multiple actions on several receptors also earned TCAs the name "dirty drugs" because of their many side effects. For example, to varying degrees TCAs block muscarinic receptors that normally bind acetylcholine, leading to anticholinergic effects. Again to varying degrees, TCAs block H1 receptors, causing sedation and weight gain. Strong binding at adrenergic receptors causes dizziness and hypotension, thereby increasing the risk for falls. Pharmacokinetics must be considered in TCA overdose fatalities because TCAs are highly lipid soluble and rapidly absorbed. This may result in cardiotoxicity and death before the client can reach a hospital, especially if the client is an older adult with a slower rate of drug elimination. (CH. 4)

A nurse is caring for a client diagnosed with severe depression. Which abnormality in the levels of the neurotransmitters are the possible causes of depression? A. Deficient production of norepinephrine B. Excess transmission of dopamine C. Deficient production of gamma-aminobutyric acid (GABA) D. Deficient production of serotonin E. Excessive production of glutamate

A, D A deficiency of norepinephrine and/or serotonin can cause depression. Excess transmission of dopamine causes schizophrenia. Deficient production of gamma-aminobutyric acid (GABA) decreases neuronal excitability and causes anxiety. Glutamate will directly influence the activity of dopamine-releasing cells. Excess glutamate production would cause excess production of dopamine, which can cause psychosis. (Ch. 4)

According to Quality and Safety Education for Nurses (QSEN), which key characteristics prepare future nurses to improve the quality and safety of the health care system? Select all that apply. A. Attitude B. Compassion C. Professionalism D. Skills E. Knowledge

A, D, E The overall goal of QSEN is to prepare future nurses to have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve quality and safety of the health care systems in which they work . Compassion and professionalism are not identified as KSA. (Ch. 1)

Which statements concerning Erikson's developmental model are true? Select all that apply. A. This model focuses on the recognition of interpersonal skills. B. The role of defense mechanisms is evaluated using this model. C. This model is an essential component of the client's evaluation process. D. Analysis of this model allows for identification of arrested development. E. Correct identification of the developmental stage supports effective care planning.

A, D, E Erikson's developmental model is an essential component of client assessment. Analysis of behavior patterns using Erikson's framework can identify age-appropriate or arrested development of normal interpersonal skills. A developmental framework helps the nurse know what types of interventions are most likely to be effective. Treatment approaches and interventions can be tailored to the client's developmental level. Evaluation of the client's progress does not involve this model. The use of defense mechanisms is associated with Freud, not Erikson. (Ch. 3)

Which questions were raised for psychiatric nurses after the first Surgeon General's report published on the topic of mental health? Select all that apply. A. Are nurses aware of the efficacy of the treatment and interventions they provide? B. What is the role of the mental health nurse? C. Are nurses accessing accurate evidence-based practice information? D. Are nurses practicing evidence-based care? E. Is there documentation of the nature and outcomes of the care nurses provide?

A, D, E, Some of the questions that were raised for psychiatric nurses after the first Surgeon General's report was published on the topic of mental health asked about the awareness of the efficacy of the treatment and interventions provided, the practice of using evidence-based care, and the documentation of the nature and outcomes of the care provided by the nurse. The actual role of the mental health nurse was not questioned. Accessing accurate evidence-based practice information was not immediately questioned after the report was published. (Ch. 1)

What QSEN standard is the nurse employing when basing care on respect for the client's preferences, values, and needs? A. Patient-centered care B. Evidence-based practice C. Safety D. Teamwork and collaboration

A. The nurse basing care on respect for the client's preferences, values, and needs is employing patient-centered care. Evidence-based care incorporates research and clinical experience. Safety ensures that risks to the clients are minimized. Teamwork and collaboration involves working together with other members of the client's health care team. (Ch. 1)

A nurse is assessing a client who demonstrates destructive tendencies. Which stage of Freud's psychosexual stages of development should the nurse analyze for this behavior? A. Oral B. Anal C. Phallic D. Latency

B According to Freud's psychosexual stages of development, there are five stages of psychosexual development. Each stage has a different focus for deriving pleasure. In anal stage the source of satisfaction is the anal region through the activity of expulsion and retention of feces. A fixation at the anal stage may result in behaviors related to anal expulsive features, like destructive tendencies, so the nurse should focus on the anal stage. In the oral stage the mouth is the source of satisfaction through activities like sucking, chewing, and biting. Fixation at the oral stage may cause sarcasm, or dependence and habits like smoking, but not specifically destructive tendencies. In the phallic stage the source of satisfaction is the genitals through masturbation. Fixation at the phallic stage may result in reckless behavior or inability to love, but not destructive behavior. The latency stage is characterized by development of the ego. Fixation at the latency stage can result in difficulty in social skills and feelings of inferiority, but not destructive tendencies. (Ch. 3)

How does the nurse explain a client's id? A. The unconscious mind B. The source of a person's instincts to save oneself from harm C. The source of problem-solving skills, perception, and the ability to mediate impulse. D. The source of judgments, values, ideals, and functions on the reward and punishment principle.

B According to Freud, at birth we are all id. The id is the source of all drives, instincts, reflexes, needs, genetic inheritance, and capacity to respond as well as all the wishes that motivate us. The ego is the source of problem-solving skills and perception, and has the ability to mediate the id's impulses. The superego is the unconscious mind and is the source of judgments, values and ideals, and functions on reward and punishment. (Ch. 3)

Systematic measurement of body weight, body mass index (BMI), waist circumference, and glucose levels would be most important for a client beginning a new prescription for which medication? A. Aripiprazole B. Olanzapine C. Ziprasidone D. Cariprazine

B Because olanzapine has metabolic side effects such as weight gain, clients beginning a new prescription of olanzapine should undergo systematic measurement of body weight, body mass index (BMI), waist circumference, and glucose levels. Aripiprazole does not require the same systematic monitoring. Ziprasidone can cause dizziness and sedation, so a nurse may monitor a client on this drug for balance and a risk of falls. Clients beginning Cariprazine would not need these systematic measurements. (Ch. 4)

Which cognitive distortion is present when a client is obsessed about a minor negative feedback to the extent that it hampers daily life? A. Labeling B. Mental filter C. Overgeneralization D. Jumping to conclusions

B Mental filter means focusing on a negative detail to the extent that it affects other important activities. Labeling is a kind of generalization that leads to forming harsh labels for oneself or for others. Overgeneralization refers to the act of applying a bad occurrence and believing that it will always be the case. Jumping to conclusions is making a negative interpretation with very little supporting evidence. (Ch. 3)

A client is taking lithium for bipolar disorder. The nurse understands that which lab values should be assessed for this client? A. Hematocrit B. Sodium level C. Hemoglobin D. Anion gap

B Primarily because of its effects on electrical conductivity, lithium has a low therapeutic index (the ratio of the lethal dose to the effective dose); therefore, it is important to monitor blood lithium levels, which are dependent on kidney function. Changes in sodium and hydration can affect the amount of lithium salts excreted. When sodium is depleted, the kidneys attempt to retain lithium and this may result in toxicity. Conversely, excessive sodium lowers lithium. Long-term use of lithium increases the risk of both kidney and thyroid disease. (Ch. 4)

Citalopram exerts its antidepressant effect by selectively blocking the reuptake of which neurotransmitter? A. Gamma aminobutyric acid (GABA) B. Serotonin C. Glutamate D. Dopamine

B Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, preferentially block the reuptake and degradation of serotonin, thereby improving depression. GABA is involved in anxiety responses. Glutamate regulation is involved in memory and learning. Dopamine regulation is involved in thought processes and movement. (Ch. 4)

Upon assessing a client who has experienced a stroke, the nurse finds that there is loss of sensation and proprioception in the left upper and lower limbs. The client has also lost the ability to distinguish between left and right side. What part of the cerebrum could potentially have a lesion? A. Frontal lobe B. Parietal lobe C. Temporal lobe D. Occipital lobe

B Sensory perception, proprioception, and the ability to distinguish between right and left are the functions of the parietal lobe of the cerebral cortex. The frontal lobe of the cerebrum is responsible for voluntary motor ability of the body. The functions of the temporal lobe include language comprehension and storing sounds in memory (language, speech). The occipital lobe functions to interpret visual images, visual association, and visual memories. (Ch. 4)

When interviewing a client who is prescribed psychotropic drugs, the nurse finds that the client has side effects such as dry mouth, constipation, and blurred vision. What is the most likely cause of these side effects? A. Blocking of alpha (α) 1 receptors B. Blocking of acetylcholine (ACh) receptors C. Blocking of serotonin (5-HT 2) receptors D. Blocking of histamine (H 1) receptors

B The blocking of acetylcholine (ACh) receptors causes symptoms such as dry mouth, constipation, and blurred vision. Therefore, the drug most likely blocks the ACh receptors. Side effects of α 1 receptor blockers include postural hypotension, dizziness, reflex tachycardia, and memory dysfunction. Drugs that block 5-HT 2 receptors may cause side effects such as hypotension and ejaculatory dysfunction. Drugs that block H 1 receptors cause sedation or drowsiness, hypotension, and weight gain. (Ch. 4)

What is the difference between intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs)? A. Only IOPs function as intermediate steps between inpatient and outpatient care. B. More time is spent with clients in PHPs than in IOPs. C. Only PHPs are located within hospitals. D. Clients are more closely monitored for relapse in IOPs than in PHPs.

B The difference between IOPs and PHPs is the amount of time spent with the clients. Both groups tend to be Monday through Friday. IOPs are usually half a day, while PHPs are longer (about 6 hours per day). Both function as intermediate steps between inpatient and outpatient care. Both are usually located within general hospitals, psychiatric hospitals, or in community settings. Clients are closely monitored for relapse in both programs. (CH. 5)

Using Maslow's model of needs, what is the nurse's priority for an anxious client? A. Assessing the client's success at fulfilling appropriate developmental level tasks B. Assessing the client for strengths upon which a nurse-client relationship can be based C. Planning one-on-one time with the client to assist in identifying the fears behind anxiety D. Evaluating the client's ability to learn and retain essential information regarding condition

B The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in the sequencing of nursing actions in the nurse-client relationship. Assessing the client for strength to build the nurse-client relationships addresses the client's need for safety and trust, which is addressing one of the basic needs. Assessing the client's success at developmental tasks, evaluating the client's ability to learn and remember, and planning one-on-one time all come after addressing the more basic need for safety. (Ch. 3)

On the fourth hospital day, a client diagnosed with major depressive disorder took an overdose of medication. Staff later learned the client had not been swallowing medications administered but instead had been saving them. Which statements accurately analyze this situation on a legal basis? Select all that apply. A. Nurses breached their duty to provide a safe environment for a client at risk for self-harm. B. Nurses created liability for themselves and their employer by failing in their duty to protect. C. In view of the client's diagnosis, nurses should have expected and assessed frequently for suicidal behavior. D. Clients have the right to refuse medication; the client's decision not to swallow the medication is an aspect of this right. E. Suicide attempts cannot be prevented in all circumstances; hospitalization protected the client from potential community hazards.

B, C Negligence is the failure to use ordinary care in any professional or personal situation when there is a duty to do so. When health care professionals fail to act in accordance with professional standards or fail to foresee consequences that other similar professionals with similar skills and education would be expected to foresee, they can be liable for their professional negligence, or malpractice. In this situation, nurses were negligent and failed to protect the client's safety by performing mouth checks after administering medications. Risk for suicide is high in clients diagnosed with major depressive disorders, so the nurses should have been assessing this client frequently for suicidal behavior. Checking that the client had been swallowing the drugs does not address the duty to provide a safe environment. Although clients have the right to refuse medication, this is not the case when a client is suicidal. In this case, hospitalization did not do enough to protect the client. (Ch. 6)

Which of the following neurotransmitters are destroyed by being taken back into the presynaptic cell in the process referred to as reuptake? A. Acetylcholine B. Dopamine C. Norepinephrine D. Serotonin

B, C, D There are two basic mechanisms by which neurotransmitters are destroyed. Some neurotransmitters (e.g., norepinephrine, dopamine, serotonin) are taken back into the presynaptic cell from which they originally were released by a process called cellular reuptake; they are either reused or destroyed by intracellular enzymes. Other neurotransmitters (e.g., acetylcholine) are destroyed by specific enzymes at the postsynaptic cell. (Ch. 4)

A client prescribed a second-generation antipsychotic (SGA) asks why the medication is referred to using that term. What will the nurse include what information in a response? A. "Some SGAs may cause excessive salivation and diarrhea." B. "SGAs are capable of treating a larger variety of mental illnesses." C. "It's used to identify the newer form of antipsychotic medications." D. "SGAs produce fewer side effects than the first-generation formulations do." E. "They contain a higher ratio of serotonin to dopamine than first-generation forms do."

B, C, D, E Several SGAs have been FDA approved to treat bipolar disorder and depression. Furthermore, because of their different binding receptor profiles, the SGAs have fewer extrapyramidal side effects (EPS). The term "second-generation antipsychotic" is a term to identify the newer form of antipsychotic medications. An SGA has a higher ratio of serotonin (5-HT2) to dopamine D2-receptor blockade than first-generation forms. Some SGAs may have significant anticholinergic and antihistamine activity, so some of the side effects may include a dry mouth and constipation rather than salivation and diarrhea. (Ch. 4)

Which common cognitive distortions are associated with the process of drawing conclusions? Select all that apply. A. Labeling B. Mind reading C. Fortune-telling D. Overgeneralization E. Emotional reasoning

B, C, E Mind reading occurs when others' negative thoughts, motives, and responses interfere and the client jumps to conclusions. Fortune-telling is when a client anticipates a negative outcome as an established fact and draws a conclusion. Emotional reasoning occurs when a client draws conclusions based on an emotional state. Labeling is a kind of generalization that leads to forming harsh labels for oneself or others. Overgeneralization is to apply a bad occurrence and believe that it will always be the case. (Ch. 3)

The science of nursing includes incorporation of theory from what topic? Select all that apply. A. Implementation of therapy models B. Nursing research C. Caring for clients D. Neurobiology E. Psychology

B, D, E The science of nursing includes incorporation of theory from nursing research, neurobiology, and psychology. Implementation of theory models and caring are considered the art of nursing. (Ch. 1)

A client is undergoing detoxification for heroin abuse. Which nursing interventions can help prevent a relapse in the future? Select all that apply. A. Helping the client understand and admit that there is a problem B. Counseling to identify the potential triggers of substance use C. Assisting in the development of awareness and commitment D. Helping to acquire skills to regain abstinence in the event of relapse E. Teaching stress management skills to help avoid substance use F. Counseling on adopting healthy coping measures and a sustainable recovery lifestyle

B, D, E, F Individuals must prepare for and anticipate the possibility of relapse to maintain long-term sobriety. A nurse can help in identifying the triggers to substance use and teaching skills to regain abstinence, stress management, and healthy coping measures. Admitting that there is a problem of addiction and developing awareness and a commitment should occur earlier in the treatment process. (Ch. 19)

When the nurse asks for advice in dealing with this client, what is the nurse manager's most helpful response? A. "You are dealing with a very difficult and resistant client; just keep with your plan." B. "If you haven't been able to establish client trust by now, ask for a change of assignment." C. "Remember that sarcasm represents the oral-stage fixation of development." D. "You are attempting to work with a client who likes to keep others off-balance."

C According to Freud's psychosexual stages of development, this client is exhibiting the oral (0 to 1.5 years) personality traits: fixation at the oral stage is associated with passivity, gullibility, and dependence, the use of sarcasm, and the development of orally focused habits (e.g., smoking, nail biting)—the nurse manager's response identifying this phase can help the nurse proceed with understanding. Suggesting that the nurse just needs to keep with the plan, that the client is keeping people off-balance, or that the nurse should request reassignment don't inform the nurse or enable her to continue treating the client effectively, so these responses are not the most helpful options. (Ch. 3)

An adult client is considering not attending an upcoming 10th high school reunion. The client tells the nurse, "I am embarrassed to go. I will not look as good as my classmates and I haven't been successful in my career." Which nurse comment most clearly addresses this cognitive distortion? A. "You look fine to me. Do think you will have fun at your reunion?" B. "Everyone ages. Other classmates have had more problems than you." C. "Do you think you are the only person who has aged and faced difficulties in life?" D. "I think you are doing well in the face of the numerous problems you have endured."

C Asking the client if he or she thinks he or she is the only person who has aged and faced difficulties addresses the cognitive distortion by helping the client identify the irrationality of the negative thought pattern. Asking the client if he or she will have fun does not address the distortion at all, nor does it address the client's concern. The nurse has no way of knowing that other classmates have had more problems, and this statement does not get at the client's own pattern of thinking. Saying that the client is doing well may be a comforting thing to say, but it does not address the negative thinking that causes the cognitive distortion. (Ch. 3)

Which theorist is considered a primary behavioral theorist? A. Freud B. Peplau C. Skinner D. Sullivan

C B.F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement. Freud is known for psychoanalytic theory, Sullivan for interpersonal theory. Peplau's work is considered to be the foundation of therapeutic nursing relationships. (Ch. 3)

Which theorist believed that the nurse's attitudes of congruence, respect, and empathetic understanding are effective in improving outcomes in clients with psychiatric illnesses? A. Jean Piaget B. Albert Ellis C. Carl Rogers D. Albert Bandura

C Carl Rogers developed a person-centered model of psychotherapy. He emphasized that attitudes of unconditional positive regard, empathetic understanding, and genuineness are essential for the nurse-client relationship and helpful for improving outcomes in a client. Albert Ellis developed an approach of rational emotive behavioral therapy. He believed in encouraging clients to accept themselves as they are, and that clients should be taught to take risks and try out new behaviors. Jean Piaget identified the stages of cognitive development stage, which are helpful in developing behavioral interventions based on cognitive levels. Albert Bandura developed the concepts of modeling and self-efficacy. He believed that desired outcomes in a client can be achieved by modifying the client's beliefs or expectation of his or her capacity. (Ch. 3)

According to cognitive theory, mental illness is caused by a faulty psychological process that can be corrected by increasing one's personal insight and understanding. Which factor challenges that this theory is not always correct? A. Invention of insulin shock therapy B. Development of psychosurgery techniques C. Identifying the effects of chlorpromazine D. Identification of specific agents that cause mental illness

C Chlorpromazine (Thorazine) is known to have a calming effect on agitated clients. The finding indicates that psychiatric illness may respond to medications that alter the intercellular components. This implies that the mental illness is also caused by disruption of intercellular components. This theory rejected the earlier psychological theory which stated that mental illness is caused by a faulty psychological process that can be corrected by increasing personal insight and understanding. Insulin shock therapy and psychosurgery techniques (surgery on specific parts of the brain) are invasive techniques that were used to modify behavior. Germ theory stated that mental illness is caused by a specific agent that is identifiable and can be eliminated. This is an old theory of the cause of mental illness and was disproved, because a single agent causing mental illness was not identified. (Ch. 3)

Which nursing activity demonstrates the role of a professional psychiatric nurse as identified by Hildegard Peplau? A. Managing the milieu B. Providing counseling C. Documenting client behaviors D. Caring for the client's physiological needs

C Hildegard Peplau identified the role of counselor or psychotherapist as the heart of psychiatric nursing and a role unique to this nursing specialty. Managing the milieu, attending to the client's physiological needs, and documenting client behaviors and responses are responsibilities of all professional nurses and are not unique to the role of a psychiatric nurse. (Ch. 3)

The nurse present a class about mental health and mental illness to a group of fourth graders. One student asks "Why do people get mentally ill?" Select the nurse's best response. A. "There are many reasons why mental illness occurs" B. "The cause of mental illness is complicated and very hard to understand" C. "Sometimes a person's brain does not work correctly because bad happens or they inherit a brain problem" D. "Most mental illnesses result from genetically transmitted abnormalities in cerebral structure"

C In the correct response, the nurse answers rather than evades the questions, provides accurate information, and uses terminology relevant to the audience (Ch. 2)

A nurse, managing a client diagnosed with depression, should expect to introduce the client to which form of short-term therapy? A. Erikson's ego theory B. Psychodynamic therapy C. Interpersonal psychotherapy D. Freud's psychoanalytical theory

C Interpersonal psychotherapy is effective short-term therapy that helps in reducing psychiatric symptoms by improving interpersonal relationships, which can be the main cause for depression. Erikson's ego theory gives a developmental model that is more useful for assessment to identify age-appropriate normal skills. Psychodynamic therapy is more suitable for relatively healthy people and is usually considered long-term with a number of sessions. Freud's psychoanalytical theory presents a human developmental process throughout childhood and its relation to human personality. (Ch. 3)

A mentally ill gunman opens fire in a crowded movie theater, killing six people and injuring others. Which comment about this event by a member of the community most clearly shows the stigma of mental illness? A. "Gun control laws are inadequate in our country" B. "It's frightening to feel that it is not safe to go to a movie theater" C. "All these people with mental illness are violent and should be locked up" D. "These events happen because American families no longer go to church together"

C Stigma refers to the array of negative attitudes and beliefs regarding mental illness. Bias, prejudice, fear, and misinformation contribute to stigma (Ch. 2)

What anatomic characteristic of the brain promotes development of ataxia as a side effect of the temazapam? A. The cerebellum has numerous glutamate receptors. B. The frontal lobe has numerous glutamate receptors. C. The cerebellum has numerous gamma-aminobutyric acid (GABA) receptors. D. The frontal lobe has numerous gamma-aminobutyric acid (GABA) receptors.

C Temazepam is a benzodiazepine drug that enhances the activity of the GABA receptors and causes sedation. There are numerous GABA receptors in the cerebellum that are stimulated by benzodiazepine drugs, causing ataxia. Increased glutamate receptor activity has an excitatory effect on the central nervous system. This can cause neurodegeneration in Alzheimer disease. Benzodiazepines do not act on glutamate receptors (NMDA and AMPA receptors). Ataxia is a movement disorder caused by cerebellar dysfunction; frontal lobe dysfunction does not cause ataxia. (Ch. 4)

The client says, "I've never been artistic. I shouldn't even come to these silly arts and crafts groups." Which comment by the nurse would be supportive of cognitive behavioral therapy (CBT)? A. "What activities do you think you would enjoy more than arts and crafts?" B. "You should try harder to finish projects that you start. You give up too easily." C. "I noticed that you made interesting color combinations and encouraged others." D. "These are simply recreational activities. Talk to your therapist about your reactions."

C The client's comment suggests distorted thinking and overgeneralization. The nurse can contribute to the CBT by recognizing positive aspects of the client's participation in the activity. When the nurse identifies interesting color combinations and the client's encouragement of others, this helps recognize the positive aspects of the client's participation. If the nurse asks the client to think of other activities, this doesn't reinforce the positive aspects of the client's participation, so this does not achieve the goal of being supportive of the CBT. The comment suggesting that the client should try harder does not provide encouragement or help the client invest in the exercises so this response is not supportive. The comment that the client should talk to his or her therapist because the activities are only recreational does nothing to support the CBT and therefore is not correct. (Ch. 3)

Which anticonvulsant mood stabilizer often prescribed for bipolar disorder carries a black box warning that includes pancreatitis? A. Ramelteon B. Lamotrigine C. Valproic acid D. Carbamazepine

C Valproic acid (Depakene) is helpful in bipolar patients unresponsive to lithium. Black box warnings for valproic acid include hepatotoxicity, tetratogenicity, and pancreatitis. Ramelteon is a melatonin receptor agonist that works as a hypnotic. The use of lamotrigine may trigger a severe allergic skin reaction called Stephens-Johnson syndrome (SJS). The use of carbamazepine warrants a periodic complete blood count due to rare, but serious blood dyscrasias (e.g., aplastic anemia and agranulocytosis). (Ch. 4)

A client being evaluated for a possible diagnosis of schizophrenia has been referred for a positron emission tomography (PET) scan. What findings in the PET scan would confirm the diagnosis in this client? A. Reduction of the temporal lobe B. Enlargement of the third ventricle C. Enlargement of the prefrontal lobe D. Decreased glucose utilization in the frontal lobes

D A PET scan is a functional imaging technique that reveals the physiological activity of the brain. In a client with schizophrenia, the scan would reveal decreased metabolic activity in the frontal lobes. Reduction of the temporal lobe and enlargement of the third ventricle are findings associated with schizophrenia, but these are revealed by structural imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT). The prefrontal lobe is atrophied in schizophrenia; an enlarged prefrontal lobe is not a finding associated with schizophrenia. (Ch. 4)

To assess a 4-year-old child's progression in the initiative versus guilt developmental stage of development, the nurse asks the parent which question? A. "Can your child put on socks without help?" B. "Does your child get upset when you leave the room?" C. "What activities does your child participate in with other children?" D. "Does your child do chores to help you out at home, such as picking up toys?"

D At this stage (early childhood or preschool), children are exposed to a larger social world and need to learn to take responsibility for demonstrating more socially acceptable behavior and expressing initiative. Questions related to physical skills, socialization and display of emotion are not associated with initiative versus guilt. (Ch. 3)

The nurse is providing education for a client who is going to begin therapy with clozapine. Which of these will the nurse prioritize in the care of this client? A. Weekly liver function tests B. Daily PT and INR C. Monthly creatinine levels D. Regular complete blood counts

D Clozapine, the first of the atypicals, is several times more potent in blocking serotonin 5-HT2 receptors than dopamine D2 receptors. It also has binding activity at a variety of other receptors, which may account for its advantages in treating patients who respond poorly to other antipsychotics. Clozapine is not a first-line treatment because it may suppress bone marrow, resulting in agranulocytosis, a rare but serious decrease in granulated white blood cells (WBCs). (Ch. 4)

Administration of which medication calls for careful nursing assessment of fluid and electrolyte balance? A. Fluvoxamine B. Clozapine C. Lamotrigine D. Lithium

D Lithium can cause disturbances in fluid balance in various body compartments. Sodium and potassium play a strong role in regulating fluid balance. Hyponatremia can increase the risk of lithium toxicity because increased renal reabsorption of sodium leads to increased reabsorption of lithium. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) and has minimal effect on fluid and electrolyte balance. Clozapine is a second-generation antipsychotic medication; it is important to monitor for agranulocytosis with administration of this drug. Lamotrigine is an anticonvulsant used as a mood stabilizer. It modulates the release of glutamate and aspartate. It is important to monitor for skin rashes with administration of this drug. (Ch. 4)

An adult experienced a spinal cord injury resulting in quadriplegia 3 years ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency? A. "I often pray for a miracle that will heal my paralysis so I will be whole again" B. "I don't know what I did to deserve this fate or whether I am tough enough to endure it" C. "My accident was a twist of fate. I suppose there are worse things than being paralyzed" D. "Being paralyzed has taken things from me but it hasn't kept me from being mentally involved in life"

D Resiliency is the ability to recover from or adjust successfully to trauma or change. A successful transition through a crisis builds resiliency for the next difficult trial (Ch. 2)

A newly divorced client assumes all blame for the failure of the marriage and feels incapable of getting involved in a future relationship. According to Freud's psychoanalytic theory, what can the nurse interpret from this behavior? A. The client's id, ego, and superego are well-balanced. B. The client's id is more powerful than superego and ego. C. The client's ego is more dominant than id and superego. D. The client's superego is more powerful than ego and id.

D The client blames him or herself for the failure of the marriage, which implies that the client is extremely self-critical. The feeling of being incapable of getting involved in a relationship in the future indicates that the client has an inferiority complex. According to Freud's psychoanalytic theory, behavior such as self-criticism and inferiority indicate that the superego is more powerful than the ego and id. In every behavior of an individual, either the id, ego or superego is dominant over the other two. The three personalities are never balanced. If the id is too powerful, the person will lack control over impulses. If the ego dominates over the id and superego, then the client behaves like a mature and well-adjusted individual. (Ch. 3)

The nurses prepares outcomes to the plan of care for an adult diagnosed with mental illness. Which strategy recognizes the current focus of treatment services for this population? A. The pt's diagnoses are confirmed using advance neuroimaging B. The nurse confers with the treatment team to identify the pt's most significant disability C. The nurse prioritizes the pt's problems in accordance with Maslow's hierarchy of needs D. The pt and family participate actively in establishing priorities and selecting interventions

D The correct response recognizes the recovery model, which has the following tenets: Mental health care is consumer and family driven, with patients being partners in all aspects of care; care must focus on increasing the consumer's success in coping with life's challenges and building resilience; and an individualized care plan is at the core of consumer-centered recovery (Ch. 1)

An adult reports frequent anxiety. Which neurotransmitter is most closely related to this symptom? A. Dopamine B. Glutamate C. Monoamine oxidase D. Gamma aminobutyric acid (GABA)

D The neurotransmitter GABA plays a role in modulating neuronal excitability and anxiety. Many antianxiety (anxiolytic) drugs increase the effectiveness of this neurotransmitter, primarily by increasing receptor responsiveness. Dopamine is involved in thought processes and regulation of movement. Glutamate is associated with memory and learning. Monoamine oxidase is an enzyme involved in regulating metabolism of norepinephrine. (CH. 4)

The nurse using the recovery model understands that the mandates of the model include what element? A. An individualized care plan at the core of consumer-centered recovery B. A hierarchical relationship between the nurse and the client C. Mental health care that is practitioner driven, with the nursing involved in all aspects of care D. Clinical practice guidelines used to increase quality and consistency of care and facilitate outcome research.

D The nurse using the recovery model understands that the mandates of the model include understanding that an individualized care plan is to be at the core of consumer-centered recovery. The emphasis on the relationship between the nurse and the client is a partnership. Mental health care is to be consumer and family driven, with clients being partners in all aspects of care. Clinical practice guidelines are systematically developed statements based on literature review that appraise and summarize the best evidence to guide clinicians in making informed decisions. (Ch. 1)

Identify the goals of inpatient psychiatric care. Select all that apply. A. Reduction of hallucinations B. Prevention of delusions C. Regulation of repetitive behaviors D. Safety E. Stabilization F. Crisis intervention

D, E, F The goals of inpatient psychiatric care include client safety, stabilization, and crisis intervention. Reduction in hallucinations may be an individual client goal. Prevention of delusions, although desirable, may not be a realistic goal for some clients. Regulation of repetitive behaviors may be an individual goal. (CH. 5)

What is the most challenging barrier to recognizing and using evidence-based practice for a new graduate practicing nursing in the psychiatric mental health area? A. Nurses may find it difficult to find the time to find and evaluate the research. B. Not all nursing problems can be solved by scientific experiments. C. Only a small amount of higher-level research is available. D. Inadequate education is provided to prepare nurses for the process.

D. The most challenging barrier is that the new graduate may be inadequately prepared by his or her undergraduate program. A lack of time and the fact that not all problems can be solved by scientific experiments are less common problems. There is a large amount of higher-level research available. (Ch. 1)

A nursing assistant says to the nurse, "The schizophrenic in room 226 has been rambling all day." When considering the nurse's responsibility to manage the ancillary staff, which response should the nurse provide? A. "It is more respectful to refer to the pt by name rather than by diagnosis" B. "Thank you for informing me about that. I will document the behavior" C. "It is not unusual for schizophrenics to do that, it is part of their illness" D. "You have a difficult job. I'm glad you are so accepting of our pts' behaviors"

A Diagnosis classify disorders that people have, not the person (Ch. 2)

The nursing practice committee has found that several research studies appear to support a change in practice. How is the evidence evaluated to ensure that it warrants a change? A. Reviewing it in the context of the hierarchical rating system B. Quantifying the number of studies found C. Assessing the experience of the researchers D. Obtaining the research from CINAHL

A Evaluating evidence is done through the hierarchal rating system. The number of studies is relevant, but only in the context of the hierarchal rating system. The experience of the researchers may not be relevant provided the study's methods are sound. CINAHL is one database for research, and other databases may be used. (Ch 1.)

A client has a diagnosis of schizophrenia. The nurse knows this is likely attributed to which imbalance? A. Increased dopamine B. Increased serum potassium C. Increased gamma-aminobutyric acid (GABA) D. Decreased number of glutamate receptors

A Norepinephrine and dopamine are increased in schizophrenia. GABA is decreased in schizophrenia. Glutamate and potassium are not neurotransmitters associated with schizophrenia. (Ch. 4)

A client who is taking olanzapine is experiencing nocturia and increased thirst. Based upon the client's symptoms, the nurse suspects that the client has developed which of these problems? A. Diabetes mellitus B. Renal calculi C. Urinary obstruction D. Hyperthyroidism

A Olanzapine, a derivative of clozapine, has comparable receptor occupancies and similar metabolic side effects, such as weight gain. Metabolic monitoring for all patients receiving SGA (atypicals) is recommended, although risperidone (Risperdal) and quetiapine (Seroquel) have a lower weight gain and ziprasidone (Geodon) and aripiprazole (Abilify) are considered weight neutral. Metabolic monitoring usually includes measurements of body weight, body mass index (BMI), waist circumference, fasting plasma glucose level, and fasting lipid profile. (Ch. 4)

What information does the Diagnostic and Statistical Manual of Mental Disorders contain? A. Mental health coding system B. Research data C. Practice guidelines D. Clinical algorithms

A The Diagnostic and Statistical Manual of Mental Disorders ( DSM) is a reference book containing the mental health coding system. The DSM does not contain research data, practice guidelines, or clinical algorithms. (Ch. 1)

According to Maslow's hierarchy of needs theory, when caring for a manic client, which symptom should be given priority? A. Lack of sleep B. Grandiose thoughts C. Hyperactive behavior D. Rapid, pressured speech

A Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priorities and must be taken care of first. Rapid, pressured speech, grandiose thoughts, and hyperactive behavior are symptoms of mania, but are not as critical as lack of sleep, so these are not the priorities. (Ch. 3)

Which nursing theorist identified the impact of internal and external stressors on the equilibrium of the system as the focus of the theory? A. Betty Neuman B. Patricia Benner C. Dorothea Orem D. Sister Callista Roy

A Betty Neuman's theory focuses on the impact of internal and external stressors on the equilibrium of the system. She implemented stress-reducing strategies for the client. Patricia Benner's theory focuses on caring as a foundation for nursing. Dorothea Orem's theory focuses on the goal of self-care as an integral part of nursing practice. Sister Callista Roy's theory focuses on the continuous need for physical, psychological, and social adaptation. (Ch. 3)

Which scenario best demonstrates empathetic caring? A. A nurse provides comfort to a colleague after an error of medication administration B. A nurse works a fourth extra shift in 1 week to maintain adequate unit staffing C. A nurse identifies a violation of confidentiality and makes a report to an agency's privacy officer D. A nurse conscientiously reads current literature to stay aware of new EBP

A Caring is evidence by empathetic understanding, actions, and patience on another's behalf; actions, words, and presence that lead to happiness and touch the heart; and giving of self while preserving the importance of self. Comforting is a part of caring, which includes social, emotional, physical, and spiritual support (Ch. 1)

A client is prescribed clonazepam. Which documented change in behavior would suggest that the treatment is successful? A. Less anxiety B. Normal appetite C. Improved sleep pattern D. Reduced auditory hallucinations

A Clonazepam is in the class of drugs known as benzodiazepines, which are the most commonly used antianxiety agents. Reporting less anxiety is a desired outcome of this therapy. This drug would not affect the client's appetite, sleep pattern, or auditory hallucinations. (Ch. 4)

Which concepts are related to the art of nursing? Select all that apply. A. Attending B. Research C. Caring D. Observation E. Advocacy

A, C, D, E Concepts related to the art of nursing include attending, caring, and advocacy. Research and observation are not concepts related to the art of nursing. (Ch. 1)

Which client problem would be most suited to the use of interpersonal therapy? A. Dysfunctional grieving B. Impaired social interaction C. Medication noncompliance D. Disturbed sensory perception

A Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit. Impaired social interaction, medication noncompliance, and disturbed sensory perception are best suited to other modes of therapy. (Ch. 3)

The nurse implementing treatments based on decisional points is using what type of clinical tool? A. Critical pathways B. Clinical algorithms C. Clinical practice guidelines D. Clinical proficiencies

B Clinical algorithms are step-by-step guidelines prepared in a flowchart or decision tree format. Alternative diagnostic and treatment approaches are described based on decisional points using a large database relevant for the symptoms, diagnosis, or treatment modalities. Critical pathways serve as a map for specified treatments and interventions to occur within specific time frames. Clinical practice guidelines are systematically developed statements based on literature review that appraise and summarize the best evidence to guide clinicians in making informed decisions. Clinical proficiencies are the skills the nurse is required to perform. (Ch. 1)

The statement, "I will always be alone because nobody could love me," is an example of what form of cognitive distortion? A. Schema B. Aversion C. Actualization D. Emotional consequence

B Schemata are unique assumptions about oneself, according to Beck's theory. This statement is an example of a negative schema. Emotional consequence is the end result of a negative thinking process, as described by Ellis. Actualization is a level of Maslow's Hierarchy of Needs. Aversion is a therapy characterized by punishment. (Ch. 3)

The nursing unit that uses data to monitor client outcomes is addressing which competency? A. Evidence-based practice B. Quality improvement C. Safety D. Patient-centered care

B. The utilization of data to monitor client outcomes is an example of addressing quality improvement. This does not address evidence-based practice, safety, or patient-centered care. (Ch. 1)

Which resource for clinical practice identifies the best evidence about prevention, diagnosis, prognosis, therapy, harm, and cost effectiveness? A. Evidence-based practice B. Internet resources C. Clinical practice guidelines D. Hierarchical rating system

C Clinical practice guidelines identify the best evidence about prevention, diagnosis, prognosis, therapy, harm, and cost effectiveness. The internet is a source to access research. Evidence-based practice is a component of clinical practice guidelines. The hierarchical rating system is a method of evaluating evidence. (Ch. 1)

How does a nurse use holistic nursing techniques to help a client? Select all that apply. A. Teach effective coping skills. B. Arrange for financial support. C. Refer the client to the community support groups. D. Encourage the client to undergo tests and medical procedures. E. Provide information regarding specific treatments.

A, B, C, E Holistic interventions include helping the client to learn effective coping skills to manage psychosocial stressors. In this process, the nurse also encourages the client to develop supportive relationships, such as through engagement in community support groups. Empowering clients to realize their full potential and independence within the limitations of their illness should include providing thorough information about treatments and options. While the nurse may provide resources to the client that may help them with financial support, if needed, the nurse should not make such arrangements directly. The nurse should use client education to encourage and empower clients to make their own decisions regarding their medical care, including tests and procedures. (Ch. 1)

An experienced nurse is teaching a group of novice nurses about the implications of cognitive behavioral therapy in nursing. Which factors should the nurse include in the teaching plan? Select all that apply. A. Recognizing interplay between negative thinking B. Encouraging one's thinking of overgeneralization C. Understanding one's response in difficult situations D. Helping the client identify negative thought patterns E. Encouraging ventilation of emotions through unconstructive thoughts

A, C, D Recognizing the interplay between negative thinking and negative outcomes is important in mental health nursing. Helping the client to identify negative thought patterns is a form of supportive therapy. Understanding one's response to difficult situations helps to appreciate the cognitive approach. Encouraging unconstructive or negative thoughts is not the goal of nursing; instead helping the client to identify negative thoughts will help. Thinking of overgeneralization is not appropriate; instead negative thoughts without facts should be challenged to find a realistic approach. (Ch. 3)

Evaluating and synthesizing the research regarding its validity, relevance, and applicability using criteria of scientific merit is an example of what? A. Assessing the performance B. Appraising the literature C. Acquiring literature D. Asking a question

B Evaluating and synthesizing the research regarding its validity, relevance, and applicability using criteria of scientific merit is an example of appraising the literature. Evaluating the outcomes, using clearly defined criteria and reports, and documenting results is an example of assessing the performance. Searching the literature for scientific studies and articles that address the issue(s) of concern is acquiring literature. Asking a question includes identifying a problem or need for change for a specific client or situation (Ch. 1)

Which priority teachings should the nurse include for a client that is beginning therapy with a monoamine oxidase inhibitor (MAOI) medication? Select all that apply. A. Take the medication at bedtime. B. Monitor blood pressure. C. Report double vision. D. Reduce tyramine intake. E. Do not take over-the-counter medication without provider approval.

B, D, E Because MAOIs block the enzyme that metabolizes monoamines, they may occasionally be used to increase the levels of serotonin and norepinephrine in intractable depression. However, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the more commonly used antidepressants because of the vasopressor effects that occur when MAOIs are combined with other sympathomimetics (amines that stimulate the sympathetic nervous system). The most feared vasopressor effect is the hypertensive crisis that can result if a client takes over-the-counter medications with pseudoephedrine or consumes the adrenergic monoamine tyramine, commonly found in aged foods, fermented foods, and certain beverages. Dietary restriction of tyramine must be maintained for 2 weeks after stopping MAOIs to allow the body to resynthesize the MAO enzyme. (Ch. 4)

The nurse planning care for a 14-year-old should include interventions to help the client achieve which developmental task? A. Establish trust B. Gain autonomy C. Achieve identity D. Develop a sense of industry

C According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood. The task of establishing trust is for infancy, so this response is incorrect. The task of gaining autonomy is the task slated for early childhood. School-aged children are tasked with developing a sense of industry. (Ch. 3)

A pt reports to a primary provider about sleeplessness, constant fatigue, and sadness. In our current health care climate, what is the most likely treatment approach that will be offered to the pt? A. Group therapy B. Individual psychotherapy C. Complementary therapy D. Psychopharmacological therapy

D The pt's reports suggest that depression is occurring. With the increased understanding of the biology of psychiatric illnesses, treatment approaches have evolved rapidly into more scientifically grounded methods, particularly psychopharmacology (Ch. 1)

Which is considered the highest quality evidence? A. Opinion of expert committees or authorities B. Well-designed randomized controlled trial (RCT) C. Single descriptive or qualitative study D. Systematic review or meta-analysis of RCT

D A systematic review or meta-analysis of an RCT is considered the highest level of quality evidence. The opinion of experts or authorities is the lowest level. A well-designed RCT is the second highest level, and a single descriptive or qualitative study is the second to lowest level. (Ch. 1)

A client who has experienced a traumatic brain injury is demonstrating abnormally fluctuating emotions. The client's history and symptoms suggest injury to which lobe of the cerebral cortex? A. Frontal B. Temporal C. Occipital D. Parietal

B The temporal lobe connects to the limbic system to allow expression of emotions. Any injury to the temporal lobe would result in abnormally fluctuating emotions. This lobe is also responsible for language comprehension. The frontal lobe is chiefly responsible for initiating voluntary activities. The occipital lobe interprets visual images and stores visual memories. The parietal lobe is chiefly concerned with the perception of sensations. (Ch. 4)

In which situation is it most urgent for the nurse to act as a patient advocate? A. An adult cries and experiences anxiety after a near miss automobile accident on the way to work B. A homeless adult diagnosed with schizophrenia lives in a community expecting a category five hurricane. C. A 14-year-old girl's grades decline because she consistently focuses on her appearances and social networking D. A parent allows the prescription to lapse for 1 day for their 8-year-old child's medication for attention-deficit/hyperactivity disorder

B While all of the scenarios present opportunities for a nurse to intervene, the correct response present an imminent danger to the pt's safety and well-being (Ch. 1)

Which scenario meets the criteria for "normal" behavior? A. An 8-year-old child's only verbalization is "no, no, no" B. A 16-year-old girl usually sleeps 3-4 hours a night C. A 43-year-old man cries privately for 1 month following the death of his wife D. A 64-year-old woman has difficulty remembering names of her grandchildren

C The death of a spouse is a difficult experience, so crying is expected (Ch. 2)

A client diagnosed with a tumor of the cerebellum is likely to demonstrate which dysfunction of which process? A. Disequilibrium B. Abnormal eye movement C. Impaired social judgment D. Blood pressure irregularities

D The cerebellum is the organ primarily responsible for maintaining equilibrium. Eye movements are controlled by the midbrain. The frontal lobe controls social judgment. The medulla maintains blood pressure. (Ch. 4)

To assess whether a school-age child is satisfactorily resolving the industry versus inferiority psychosocial crisis, what question should the nurse ask the parent? A. "Is your child able to bathe and get dressed daily without your help?" B. "What is your child's reaction when you are separated for an extended period of time?" C. "How would you describe your child's academic, physical, and social accomplishments?" D. "What do you think are the strongest and weakest features of the relationship between you and your child?"

C The correct response assesses developing social, physical, and school skills. During this stage, the child's task is to gain a sense of personal abilities and competence and to expand relationships. Attainment of this task (industry) brings with it the virtue of confidence and, later in life, competence and an ability to work. The ability of the child to get dressed daily, the child's reaction upon separation, and the strongest and weakest features of the parent-child relationship relate to other psychosocial crises. (Ch. 3)

Antidepressant medication is prescribed for a client who has high levels of cytochrome P-450 (CYP) enzymes. Which outcome is most likely? A. The rate of drug absorption will be high. B. The rate of drug absorption will be low. C. The rate of drug metabolism will be quick. D. The rate of drug metabolism will be slow.

C The level of cytochrome P-450 (CYP) alters drug metabolism. High levels of CYP increase the metabolism of antidepressant drugs. CYP levels do not affect drug absorption, so they would not make it too low or too high. Low levels of CYP decrease the metabolism of the drugs. (Ch. 4)

The nurse interacts with a veteran of World War II. The veteran says, "veterans of modern wars whine and complain all the time. Back when I was in service, you kept your feelings to yourself. Select the nurse's best response. A. "American society in the 1940s expected World War II soldiers to be strong" B. "World War II was fought in a traditional way but the enemy is more difficult to identify in today's wars" C. "We now have a better understanding of how trauma affects people and the importance of research-based, compassionate care" D. "IEDs, which were not in use during World War II, produce traumatic brain injuries that must be treated"

C Trauma occurs in many forms, including physical, sexual, and emotional abuse as well as war, natural disasters, and other harmful experience. Trauma-informed care provides guidelines for integrating an understanding of how trauma affects pts into clinical programming (Ch. 1)